Blunted Emotions / People with schizophrenia
often seem emotionally flat and unresponsive to things happening around
them. They may be unable to show emotion by varying their facial expressions,
gestures, or tone of voice. The person may not show much response to happy
or sad events, or may respond in an inappropriate way. In some types of
schizophrenia, especially the hebephrenic or disorganised type (see below),
grossly inappropriate and incongruous emotions and actions are among the
main symptoms. The person may appear to be misdirected, goalless, playfully
intrusive, and often impulsive. The whole personality of the person with
schizophrenia often appears to be changed from its previous pattern.

Loss of Drive / Schizophrenia may reduce
people's motivation so that they are less able to work or participate
in leisure activities. They may seem uninterested in everyday activities
such as washing and cooking or, in extreme cases, may be unable to care
for their personal hygiene or feed themselves. Indecision, negativism,
and passivity may appear, mixed with sudden impulses. In extreme cases,
the person may become withdrawn, agitated, or stuporous for no apparent
reason.

Social Withdrawal / People with schizophrenia
may have difficulty making and keeping friends or acquaintances; they
may have few, if any, intimate relationships. Their interactions with
others may be brief and superficial. In extreme cases, the person may
actively avoid all social interactions.

Poverty of Thought / Some people with schizophrenia
reveal a marked reduction in the amount and content of their thinking.
They may only rarely speak spontaneously and may answer questions with
short answers that provide no detail. In extreme cases, the person's speech
is limited to short phrases such as "yes," "no," or
"I don't know." Other people with schizophrenia may talk freely,
but their speech, while comprehensible, does not really convey any content.
They may answer questions in a roundabout way that never gets to the point.
Their speech may reflect loose or unrelated associations between ideas
and incomprehensible breaks and jumps in the train of thought.
The negative symptoms of schizophrenia are
often misinterpreted by others as a sign that the person is lazy or purposely
misbehaving to annoy others rather than being seen as part of the illness.
Such a misinterpretation contributes in a large way to the negative image
and stigma associated with schizophrenia.
In assessing negative symptoms that are
not accompanied by positive symptoms, the clinician should evaluate for
a change from previous behaviour. Although negative symptoms that occur
in the absence of positive symptoms are often missed, the person with
negative symptoms only still needs help.
In cultures in which frequent and intense
social interaction is the norm (e.g., many Western cultures), the presence
of negative symptoms may be particularly stigmatising. It is extremely
important to take culture into consideration in evaluating negative symptoms
and their impact.
Unlike positive symptoms, negative symptoms
are more subtle deficits in functioning that are often not recognised
as symptoms of the illness. Sometimes family members or others misinterpret
the negative symptoms of schizophrenia as a sign of "laziness."
For example, if the person is unmotivated and unconcerned about personal
appearance, they may think that he or she is just too lazy to bother or
is neglecting his or her appearance to annoy the family.
Negative symptoms may also be the result
of depression (which can occur at the same time as schizophrenia) or an
understimulating environment (such as a prolonged hospital stay), or may
actually represent side effects of some antipsychotic medications. It
is often hard to tell if negative symptoms are a part of the schizophrenic
illness itself or the result of these other problems.
The person's ability to work, to interact
with others, and to care for himself or herself during remission depends
to a large extent on the severity of the person's residual negative symptoms.
Most people with schizophrenia only have a few positive and negative symptoms
at any given time. Typically, the type and severity of symptoms vary considerably
over the course of the illness and from one person to another. Some individuals
never have hallucinations; others never have delusions; some never have
negative symptoms while others suffer from them persistently.
Negative symptoms are associated with the
stigma of psychological weakness, lack of will or drive to lead a more
active and participatory life, and an inability to take care of oneself.
The results of negative symptoms may be perceived as a voluntarily chosen
life-style characterised by social withdrawal and a lack of responsibility
toward others. Negative symptoms are often associated with the stigma
of being lazy.
The person's ability to work, to interact
with others, and to care for himself or herself during remission depends
to a large extent on the severity of the person's residual negative symptoms.